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Exercise for the management of cancer-related fatigue in adults

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Fatigue is a common and potentially long-lasting side effect of cancer and cancer treatment, which may last for months or years. As a result of improved therapy, people with cancer are surviving longer and having to deal with long-term consequences of the disease and its therapy. Fatigue can have a significant impact on quality of life, not only interfering with daily activities, but also having the potential for negative social and economic consequences

Dealing with cancer-related fatigue is crucial to effective treatment, because those who suffer the effects of fatigue may be less inclined to continue with treatment. In the past, people with cancer-related fatigue were frequently advised to rest; current advice is that long periods of inactivity may lead to muscle wasting and increased tiredness, whereas balancing rest with physical activity may help to reduce fatigue.

For healthy individuals, research has shown that exercise can reduce fatigue and increase exercise tolerance. It may also improve mood and reduce anxiety. However, it was unclear whether exercise would be beneficial for patients with fatigue arising from their cancer or its treatment.

A 2008 Cochrane Review found some benefits of physical activity for fatigue in cancer, based on limited studies. The research team has updated the review, adding another 28 studies to those assessed in 2008. Altogether, the newly updated Cochrane Review includes 56 studies, involving a total of 4068 people undergoing cancer treatment. The findings indicate that those with solid tumours benefited from aerobic exercise, such as walking or cycling, both during and after cancer treatment. Other forms of exercise, however, including resistance training, did not significantly reduce fatigue.

“The evidence suggests that exercise may help reduce cancer-related fatigue and should therefore be considered as one component of a strategy for managing fatigue that may include a range of other interventions and education,” said lead researcher Fiona Cramp of the Faculty of Health & Life Sciences at the University of the West of England in Bristol, UK. “This updated review provides a more precise conclusion, showing specifically that aerobic exercise, both during and after cancer treatment, can be beneficial.”

Further research is needed to understand how the frequency and duration of exercise, as well as the type of cancer, affect the results. “Twenty-eight of the studies we included were carried out in breast cancer patients, so we need to know more about how exercise can help people with a broad range of diagnoses, including patients with advanced disease,” said Cramp.

The research was funded by the UK’s National Institute for Health Research (NIHR) Health Technology Assessmentprogramme.